A: The goal of treatment for metastatic breast cancer is to help you live as long as possible with the best quality of life. Even though there is no cure for metastatic breast cancer yet, there are many treatments that can slow the progression of the disease and even stop it from progressing for an extended period of time. Many of these treatments have relatively mild side effects, but some of them may have side effects that disrupt your quality of life.
It is extremely important to realize that you do not have to stay on any treatment that’s making you miserable. Tell your healthcare providers immediately if a treatment is causing you pain or discomfort, and together you will be able to decide whether to try changing the dose, taking a break, or switching to a different treatment.
Reviewed by Clifford A. Hudis, MD
A: Treatment side effects are different for every person, and they can also change over time, so there is no single answer to this question. Important points to remember about side effects the second time around include:
- Even if you had a terrible time with side effects in the past, you may not have the same experiences again.
- New ways of minimizing side effects are constantly being developed. There may be medicines available now to lessen nausea, pain and other side effects that were not available when you were first diagnosed.
- The goals of treatment for metastatic breast cancer are different from the goals of adjuvant treatment (treatment to lower the risk of recurrence) in early breast cancer. In early breast cancer, higher doses of chemotherapy medicines are given, usually in combination, which lead to more side effects. In advanced breast cancer, treatments are often given one at a time, and lower doses of chemotherapy are given to control the cancer on an ongoing basis.
- Doctors and nurses who treat women with metastatic breast cancer are trying to find treatments that not only will best control the cancer, but also will allow you to enjoy the best possible quality of life. So if you tell them that a treatment is making you uncomfortable or causing too much disruption to your daily life, they will work with you to find an alternative.
Reviewed by Evelyn Robles-Rodriguez, RN, MSN
A: The fatigue you are experiencing could be due to:
- the cancer
- the treatments you are taking
- the emotional impact that stems from dealing with metastatic breast cancer
Sometimes fatigue is caused by low red blood cell counts. Talk to your medical oncologist to see what methods you can use to safely address this problem.
Other women find they have trouble sleeping or feel tired all the time because they are depressed, a psychological condition that affects some women with metastatic breast cancer. Physical activity or medicines to treat depression may improve your energy level.
Whatever the cause of your fatigue, you can make lifestyle changes to improve your quality of life. These changes include saving your energy for the activities you value most, and asking family and friends for help with household chores or other things. If fatigue persists in spite of efforts to reduce it, you also might want to talk with your oncologist about whether medicines, such as methylphenidate (Ritalin) or modafinil (Provigil) can improve your energy and relieve your fatigue.
Reviewed by Mary K. Hughes, MS, RN, CNS, CT
- Try to sleep in cool conditions—turn the thermostat down at night, and use an air conditioner or fan during the hot months.
- Sleep in cotton pajamas or a nightgown. Cotton breathes more than other fabrics and should keep you more comfortable.
- Take a cool shower before bed and keep ice water by the bedside that you can sip when hot flashes hit.
- Increase the amount you exercise during the day.
- Avoid drinking alcohol and eating spicy foods.
If these lifestyle changes don’t relieve your hot flashes, you might want to ask your doctor about medicines. Because you have breast cancer, you probably won't be able to take estrogen, the traditional treatment for hot flashes. But there are a number of other medicines that may ease hot flashes, including low doses of certain antidepressants, the anti-seizure medication gabapentin (Neurontin), megestrol acetate (Megace) and the blood pressure medicine clonidine (Catapres). Side effects are linked to some of these medicines, and some may take several weeks before they start working against hot flashes. By reviewing your medical history, your doctor can tell you which of these medicines might work best for you.
Reviewed by Mary K. Hughes, MS, RN, CNS, CT
- Although treatment side effects vary considerably from woman to woman, the best resources for this type of information are often other women who are going through the same types of treatments. To find someone to talk to, try calling our Helpline at (888) 753-LBBC (5222). We can match you with a woman who is in a situation similar to yours.
- Your healthcare team can also provide valuable information about side effects and how to manage them. Don’t be afraid to ask for detailed explanations regarding the possible side effects of any treatment you are considering.
- Read LBBC’s Guide to Understanding Symptoms and Treatment Side Effects of Advanced Breast Cancer.
- Frankly Speaking About Advanced Breast Cancer, a 62-page booklet developed by LBBC and Cancer Support Community, has information on the latest treatments, side effects and side-effect management.
- Listen to the podcast or download publications from our Annual Conference for Women Living with Metastatic Breast Cancer.
- For a comprehensive list of resources and support for women with advanced breast cancer, you can also go to AdvancedBC.org, a website created by breast cancer advocate and author Musa Mayer.
Reviewed by Elyse Spatz Caplan, MA